MEDICARE: STANTON S LEBOUITZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	MD011092E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255322798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STANTON S LEBOUITZ M.D.

Provider Business Mailing Address
First Line	:	1936 POWDER MILL RD
Second Line	:	SUITE A
City	:	YORK
State	:	PA
Zip	:	17402-4725
Country	:	US
Telephone Number	:	717-741-0811
Fax Number	:	717-741-9499

Provider Business Practice Location Address
First Line	:	1936 POWDER MILL RD
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-4725
Country	:	US
Telephone Number	:	717-741-0811
Fax Number	:	717-741-9499

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	05/16/2014

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